Scientific Poster Session III - Clinical Pharmacy Forum

Clinical Pharmacy Forum
  Monday, October 14, 2024
  01:00 PM–02:30 PM

Abstract

Service or Program: The FDA updated package labeling for 5-fluorouracil and capecitabine to highlight the increased risk of TRAEs for DPYD variant carriers. Pharmacists from the Penn Medicine Center for Genomic Medicine and gastrointestinal oncology championed efforts to employ preemptive DPYD testing for patients receiving fluoropyrimidine (FP) therapy. In a collaborative effort with clinical, laboratory, and informatics colleagues, our team was able to: 1) develop an expanded DPYD panel test to include variants found non-European populations, 2) integrate discrete results into the electronic health record (EHR) with clinical decision support (CDS), and 3) incorporate preemptive testing into clinical workflow.

Justification/Documentation: Preemptive DPYD testing is standard practice in Europe and is recommended by the European Medicine Agency (EMA), but not in the United States. In the Implementing Pharmacogenetic Testing in Gastrointestinal Cancers (IMPACT-GI) study, we measured implementation outcomes and found 57.4% feasibility (the number of PGx results returned prior to cycle 1 of chemotherapy) and 100% fidelity (the number of times providers adjusted dosing according to patient genotype) when results were returned prior to cycle 1. Compared to a historical population of DPYD variant carriers, the rate of TRAEs requiring admission, emergency department or oncology evaluation center visits decreased from 50% to 38%. PGx-guided FP dose reduction led to decreased treatment modification (13% vs 70%) and treatment discontinuation (13% vs 40%).

Adaptability: This service was implemented in an ambulatory oncology setting at three sites in our health system. Strong stakeholder buy-in (e.g. providers, information technology services, laboratory) is vital for this multidisciplinary effort.

Significance: Pharmacists play a key role in implementing PGx services to further optimize chemotherapy and improve patient safety. PGx-guided dosing for DPYD variant carriers led to decreased severe TRAEs, treatment modifications, and treatment discontinuations compared to a historical population. We anticipate this model will improve patient safety as we expand to other oncology care sites.

Presenting Author

Mari Cayabyab PharmD
Hospital of the University of Pennsylvania

Authors

Joseph Bleznuck NA
University of Pennsylvania

Donna Capozzi PharmD
Hospital of the University of Pennsylvania

Nevena Damjanov MD
University of Pennsylvania Perelman School of Medicine

Hakon Hakonarson MD, PhD
The Children’s Hospital of Philadelphia

Rachel Hatch PharmD
Hospital of the University of Pennsylvania

Glenda Hoffecker PharmD
University of Pennsylvania

Ryan Massa MD
University of Pennsylvania Perelman School of Medicine

Jean De Dieu Ndayishimiye PharmD
University of Pennsylvania

Randall Oyer MD
Lancaster General Health

Nandi Reddy MD
Lancaster General Health

Avni Santani Ph.D.
The Children’s Hospital of Philadelphia

Ursina Teitelbaum MD
University of Pennsylvania Perelman School of Medicine

Sony Tuteja Pharm.D., MS, BCPS
University of Pennsylvania Perelman School of Medicine

Lisa A. Varughese PharmD
University of Pennsylvania

Xingmei Wang MS
University of Pennsylvania

Victoria Wittner MPH
University of Pennsylvania